Inke Mathauer. Community based health insurance: how can it contribute to progress towards UHC? Geneva: World Health Organization; 2017. Geneva: World Health Organization; 2010. WHO. https://doi.org/10.1093/heapol/czt054. To ensure key development programmes are adequately funded [5,6]. In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. The function of pooling and the ways that countries organize this is critical for countries progress towards universal health coverage, but its potential as a policy instrument has not received much attention. 0000010246 00000 n When people have access to publicly financed coverage schemes, this VHI is duplicating. 0000011158 00000 n This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 0000074834 00000 n But the key concern is that the existence of multiple pools implies fragmentation. 0000008166 00000 n The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Mathauer I, Dale E, Meessen B. Programs build local capacity to track public and private health spending. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. Many others receive poor quality of services even when they pay out-of-pocket. The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. 2019, 5/393(10166):75102. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Decentralized countries often have pools organized by government administrative levels. Cuba, with a much larger population, also has this setup, as does Sri Lanka, where financial protection performance is relatively good despite a high share of OOP [29]. As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. An appraisal of the health transformation Programme. This is commonly referred to as a competitive social health insurance arrangement. Moreover, in France, there is a shift towards compulsory complementary coverage, which employers have to buy for their employees since 2016 (with exceptions for various employee groups) [56]. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. Thomson S. What role for voluntary health insurance? The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. Finally, we are grateful for valuable comments from two anonymous peer reviewers. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Implementing health financing reform: lessons from countries in transition. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. The health financing system in the country is complex as it involves different layers of financial sources, . A multiple pool setup can be based on population segmentation, i.e. 0000064650 00000 n Int J Equity Health. 2013;91(8):60211. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. Geneva: World Health Organization; 2010. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. 192 0 obj<>stream As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. PubMed Central Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. 2. 0000006049 00000 n Pools can be based on compulsory, automaticor voluntary participation. Today, millions of people do not access services due to the cost. 0000003726 00000 n A critical requirement of this pooling arrangement is thus the riskadjustment of the revenues that go to each insurer as a means to limit segmentation of the population into different pools based on their health risks and to address inequities in resources available across different pools [38]. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. All people have in principle access to the same benefits. xref Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. What are the four major services and healthcare? Health Financing in Ghana. Health financing - World Health Organization. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 2016;15:57. Forum for Health Economics & Policy; 1998: 1 (1). Geneva: World Health Organization; 2017. The three roles of health managers are interpersonal, informational and decisional. Springer Nature. Health Care Syst Transit. Book 0000007449 00000 n the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Akerlof GA. A single pool maximizes the potential for risk pooling across the whole population. 0000009066 00000 n Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. Strategic purchasing for universal health coverage: key policy issues and questions. sicker individuals would have to pay more because they would need more health services [18]. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. 0000012547 00000 n Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. 8. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. The complex structure of Australia's . Based on this, we propose a classification with eight broad types of pooling arrangements. 0000013724 00000 n 2014;29:71731. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. Privacy Explain the need for evidence pertaining to the cost of delivery of. PubMed Central On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. 2016;18(2):1239. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Taskforce on Innovative International Financing for Health Systems. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Provided by the Springer Nature SharedIt content-sharing initiative. 2018;122:45772. 2011;13(7):1190. . Conversely, schemes that have voluntary membership, i.e. they try to enroll members with low health risks relative to their contributions in order to incur lower health costs and thus reach a larger margin between revenues and expected expenditures. trailer Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. Advances in health economics and health services research, volume 21. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Thailand Health Systems in Transition. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Access services due to the cost of delivery of brief no are functions of health financing for valuable comments from two anonymous reviewers... 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